Hospital Patients Research Articles

Chronic kidney disease and risk factors among Type 2 Diabetic patients in selected hospitals in Dhaka, Bangladesh

Chronic kidney disease (CKD) may be defined as abnormalities of kidney function or structure present for more than 3 months. Around 10% of people worldwide have CKD. The data about chronic kidney disease among diabetics in Bangladesh is inadequate, and very few studies have been done on specific populations, i.e., male or female. Thus, the study aims to determine the prevalence of CKD and its risk factors among diabetic patients in selected hospitals in Dhaka city. The specific objectives of the study were to assess the participants through physical and laboratory evaluations, categorize them into the different stages of CKD, analyze their socio-demographic characteristics, and determine the association between CKD and various risk factors. This is a cross-sectional study. The study population consisted of different outpatient diagnostic centers and outpatient and indoor patients of Shaheed Suhrawardy Medical College and Hospital. The sample size of the study is 369. The Modification of Diet in Renal Disease equation was used to calculate eGFR. This study revealed that in Dhaka, 18.2% of Type 2 Diabetic patients had CKD. Most of the participants were between 46 and 65years old. Most of the CKD patients had a low education level and a lower family income. Having diabetes for more than 3 years and hypertension for more than 5 years were associated with a higher risk of developing CKD, especially among individuals who consumed added salt in their diet.

Potential drug-drug interactions and associated factors among hospitalized pediatric patients in Adigrat general hospital, Tigrai, north Ethiopia: a retrospective cross-sectional study

BackgroundDrug-drug interactions (DDIs) are associated with increased or decreased adverse effects and decreased or decreased therapeutic effects. Hospitalized pediatric patients are exposed to a number of potential DDIs (pDDIs). There are limited studies on pDDIs among pediatric patients in Ethiopia. This study was aimed to evaluate the pDDIs and associated factors among hospitalized pediatric patients in Adigrat general hospital, Tigrai, northern Ethiopia.MethodsA retrospective cross-sectional study was carried out among hospitalized pediatric patients in Adigrat general hospital from 01 July 2020 to 31 August 2020. A simple random sampling technique was used to select medical charts. Micromedex 2.0 database was used to screen pDDIs. Data was analyzed using statistical package for social science version 21 and a P-value of ≤ 0.05 was considered statistically significant.ResultsOf the total 146 patients studied, 100 (68.5%) were exposed for at least one pDDI. A total of 158 pDDIs consisting of 33 distinct interacting drug pairs were identified. About 19.3% of the patients had at least one major pDDI, 6.7% at least one moderate and 68.9% at least one minor pDDIs. On the other hand, 63.3% of the total pDDIs were minor and 25.9% major while 3. 8% were contraindicated pDDIs with 15.2% fair and 81.6% good level of documentation. The overall mean duration of pDDIs exposure was about 4.9 (1-23) days. The frequently occurring potential clinical consequences of pDDIs comprised increased risk of QT-interval prolongation (10.1%), theophylline toxicity (5.1%), antiepileptic toxicity (5.1%) and formation of ceftriaxone calcium precipitates (3.8%). Infant/toddler age group (adjusted odds ratio [AOR] = 31.961, 95% CI: 1.117-914.528), number of diseases (AOR = 0.255, 95% CI: 0.069-0.939) and polypharmacy (AOR = 0.276, 95% CI: 0.091-0.838) were associated with pDDIs exposures.ConclusionsA large number of pediatric patients were exposed to a various pDDIs. Age, number of diseases and polypharmacy predicted for the occurrence of pDDIs. Besides, the major severity pDDIs encounted frequently in the current study can potentially lead to a life threatening cardio-vascular toxicicty from QT-interval prolongation. Clinicians should be vigilant to pDDIs to prevent potential clinical consequences of pDDIs. Moreover, computerized drug interaction screening and clincal pharmacy services should be practiced to improve patients’ safety.

Development and validation of a prediction model for gastric cancer: a single-center prospective study.

This study aimed to develop and validate a novel nomogram for diagnosing gastric cancer (GC). In this prospective analysis, 146 patients of Wenzhou Central Hospital were recruited for a GC group and a benign lesion group and were divided into a training set and an internal validation set in a ratio of 7:3. Clinical and analytical characteristics were collected and analyzed by logistic regression analysis. The performance of the predictive model was evaluated using the receiver operating characteristic curve, calibration curve, and decision curve analysis. There were 5 variables, namely albumin, carcinoembryonic antigen, carbohydrate antigen 125, creatinine, and small proline-rich protein 2A, that were identified as the final parameters for the developed model. In the training and internal validation sets, the area under the curve of the model was 0.968 and 0.979, respectively, showing good diagnostic performance. This study developed and validated a new nomogram based on 5 parameters. This model shows good diagnostic performance in distinguishing GC from benign lesion groups and has certain significance in clinical application.

Varicella zoster infection in Pediatric oncology patients in Hue Central Hospital, Vietnam

Abstract Background Varicella zoster infection in pediatric oncology patients presents a big challenge. It could lead to a severe, prolonged and disseminated infection with complications in multiple organs. This study aimed to investigate varicella zoster infection in pediatric oncology patients at Hue Central Hospital, Vietnam in order to describe demographic, epidemiological, clinical features and complications. Methods Varicella zoster infections among children with cancer were identified between January 8 to November 4, 2023, at Hue Central Hospital. Varicella zoster infection was diagnosed clinically based on the presence of typical skin manifestations. Data were abstracted from patient medical records and analyzed in SPSS v.18.0 (IBM Corp., Armonk, NY, USA). Results From January 8 to November 4, 2023, a total of 20 patients with malignancies were identified as having varicella zoster, with a median age of 3.5 years (range: 1 years to 16 years). All these patients did not received varicella zoster vaccine. Almost half of the patients had solid tumor (n=11, 55.0%), and other half had leukemia (n=9, 45.0%). Some of them (n=7, 35.0%) were receiving chemotherapy, and other (n=13, 65%) just finished chemotherapy. Most children were hospitalized (n=16, 80.0%) and they were given oral acyclovir (n=18, 90.0%). Three children (15.0%) required critical care (severe infection, acute pancreatitis, and multiorgan failure (MOF)), and one (5.0%) died from disseminated and progressive varicella with MOF and suspected varicella zoster meningitis. Chemotherapy was delayed or omitted due to varicella in 70.0%. Some of the children with varicella acquired from their parents. There were 5 parents who got varicella zoster when taking care patients at the hospital. All patients were likely to expose other patients in the wards. Conclusion Children with cancer are at extra risk of varicella zoster infection and progression to severe disease due to their immunocompromised status. Optimizing vaccination of care providers, such as their relatives, will prevent transmitting virus to the patients.

In vitro activity assessment of cefiderocol against Enterobacterales, Pseudomonas aeruginosa, and Acinetobacter spp., including β-lactam nonsusceptible molecularly characterized isolates, collected from 2020 to 2021 in the United States and European hospitals.

This study reports the activity of cefiderocol against Enterobacterales, Pseudomonas aeruginosa, and Acinetobacter spp. isolates collected from the United States and Europe, including Israel and Turkey, from 2020 to 2021. Among Enterobacterales, 2.8% were carbapenem nonsusceptible (CNSE); cefiderocol inhibited 96.6%/85.1% [Clinical Laboratory Standards Institute (CLSI)/European Committee on Antimicrobial Susceptibility Testing (EUCAST) breakpoints] of these isolates. Imipenem-relebactam, meropenem-vaborbactam, and ceftazidime-avibactam displayed susceptibilities lower than cefiderocol against CNSE isolates (67.4-84.6% susceptible, CLSI). Cefiderocol was the only agent active against CNSE isolates carrying metallo-β-lactamase (MBL) carbapenemase or multiple carbapenemase genes (84.6%-92.3% susceptible, CLSI). Approximately 18% of carbapenem-susceptible Escherichia coli, Klebsiella pneumoniae, and Proteus mirabilis carried extended-spectrum-β-lactamases and/or plasmid-borne AmpC-encoding genes; cefiderocol inhibited 99.8%-100.0% (CLSI) of these genotypic groups. Multi-drug resistance (MDR) phenotypes were observed in 16.9% and 52.5% of P. aeruginosa and A. baumannii-calcoaceticus isolates, respectively. Carbapenemase genes were rare (4.9%) among cephalosporin and/or carbapenem nonsusceptible P. aeruginosa, compared to 87.6% carriage in A. baumannii-calcoaceticus, respectively. Against the MDR and carbapenemase-carrying P. aeruginosa and A. baumannii-calcoaceticus subsets, cefiderocol was active against 98.6%/98.7% and 97.1%/97.4% (CLSI), respectively. Only 69 isolates (0.3%) across all species groups were identified as cefiderocol nonsusceptible per CLSI criteria (>4 mg/L). Cefiderocol was the most active agent in vitro against Enterobacterales, P. aeruginosa, and Acinetobacter spp., with uniform activity against all phenotypic- and genotypic-resistant subsets. Coupled with the low incidence of nonsusceptibility observed across species groups, these results demonstrate cefiderocol as an important option for treating infections caused by pathogens with diverse mechanisms of resistance in US and European hospitals.IMPORTANCEThe worldwide spread of multi-drug-resistant Pseudomonas aeruginosa and carbapenem-resistant Enterobacterales and Acinetobacter spp. poses a serious challenge in healthcare settings as infections caused by these organisms are commonly refractory to many frontline therapeutic agents. Multiple global health organizations highlighted these pathogens as critical priorities for new antibiotic development, thus necessitating continued surveillance of the activities of currently available antimicrobial agents and circulating mechanisms of resistance. To meet this need, this study phenotypically and genotypically characterized priority Gram-negative pathogens collected from patients in US and European hospitals to examine the activity of cefiderocol and other currently available treatment options, including carbapenems and β-lactam-β-lactamase inhibitor combinations. The results presented here provide a detailed perspective to healthcare practitioners of cefiderocol's broad applicability, manifested in high activity and low nonsusceptibility rates, across phenotypic and genotypic organism groups relative to other agents and further support its use against the most intransigent infections.

The evaluation of SARS-CoV-2 mutations at the early stage of the pandemic in Istanbul population

BackgroundDetermination of SARS-CoV-2 variant is significant to prevent the spreads of COVID-19 disease.MethodsWe aimed to evaluate the variants of SARS-CoV-2 rate in positive patients in Kanuni Sultan Suleyman Training and Research Hospital (KSS-TRH), Istanbul, Türkiye between 1st January and 30th November 2021 by using RT-PCR method.ResultsHerein, 825,169 patients were evaluated (male:58.53% and female:41.47%) whether COVID-19 positive or not [( +):21.3% and (−):78.7%] and 175,367 patient was described as positive (53.2%-female and 46.8%-male) by RT-PCR. COVID-19 positive rate is observed highest in the 6–15- and 66–75-year age range. The frequencies were obtained as SARS-CoV-2 positive (without mutation of B.1.1.7 [B.1.1.7 (U.K), E484K, L452R, B.1.351 (S. Africa/Brazil) spike mutations] as 66.1% (n: 115,899), B.1.1.7 Variant as 23.2% (n:40,686), Delta mutation (L452R) variant as 9.8% (n:17,182), B.1.351 variant as 0.8% (n:1370) and E484K as 0.1% (n: 230). In April 2021, general SARS-CoV-2 and B.1.1.7 variant were dominantly observed. Up to July 2021, B.1.617.2 (Delta variant/ Indian variant) and E484K has been not observed. B.1.351 variant of SARS-CoV-2 has been started in February 2021 at the rarest ratio and March 2021 is the top point. September 2021 is the pick point of E484K. African/Brazil variant of SARS-CoV-2 has been started in February 2021 at the rarest ratio and March 2021 is the top point. September 2021 is the pick point of E484K. When the gender type is compared within the variants, women were found to be more prevalent in all varieties.ConclusionsThe meaning of these mutations is very important to understand the transmission capacity of the COVID-19 disease, pandemic episode, and diagnosis of the virus with mutation types. Understanding the variant type is important for monitoring herd immunity and the spread of the disease.

Investigation of Citrobacter freundii clinical isolates in a Chinese hospital during 2020-2022 revealed genomic characterization of an extremely drug-resistant C. freundii ST257 clinical strain GMU8049 co-carrying blaNDM-1 and a novel blaCMY variant.

The emergence of multidrug-resistant Citrobacter freundii poses a significant threat to public health. C. freundii isolates were collected from clinical patients in a Chinese hospital during 2020-2022. An unusual strain, GMU8049, was not susceptible to any of the antibiotics tested, including the novel β-lactam/β-lactamase inhibitor combination ceftazidime-avibactam. Whole-genome sequencing (WGS) revealed that GMU8049 harbors a circular chromosome belonging to the rare ST257 and an IncX3 resistance plasmid. Genomic analysis revealed the coexistence of two β-lactamase genes, including plasmid-mediated blaNDM-1 and chromosomal blaCMY encoding a novel CMY variant, combined with an outer membrane porin deficiency, which may account for the extreme resistance to β-lactams. Conjugation experiment confirmed that the blaNDM-1 resistance gene located on pGMU8049 could be successfully transferred to Escherichia coli EC600. The novel CMY variant had an amino acid substitution at position 106 (N106S) compared to the closely related CMY-51. Additionally, a GMU8049-specific truncation in an OmpK37 variant that produces a premature stop codon. Moreover, a variety of chromosome-located efflux pump coding genes and virulence-related genes were also identified. Analysis of strain GMU8049 in the context of other C. freundii strains reveals an open pan-genome and the presence of mobile genetic elements that can mediate horizontal gene transfer of antimicrobial resistance and virulence genes. Our work provides comprehensive insights into the genetic mechanisms of highly resistant C. freundii, highlighting the importance of genomic surveillance of this opportunistic pathogen as a high-risk population for emerging resistance and pathogenicity.IMPORTANCEEmerging pathogens exhibiting multi-, extremely, and pan-drug resistance are a major concern for hospitalized patients and the healthcare community due to limited antimicrobial treatment options and the potential for spread. Genomic technologies have enabled clinical surveillance of emerging pathogens and modeling of the evolution and transmission of antimicrobial resistance and virulence. Here, we report the genomic characterization of an extremely drug-resistant ST257 Citrobacter freundii clinical isolate. Genomic analysis of GMU8049 with a rare ST type and unusual phenotypes can provide information on how this extremely resistant clinical isolate has evolved, including the acquisition of blaNDM-1 via the IncX3 plasmid and accumulation through chromosomal mutations leading to a novel CMY variant and deficiency of the outer membrane porin OmpK37. Our work highlights that the emergence of extremely resistant C. freundii poses a significant challenge to the treatment of clinical infections. Therefore, great efforts must be made to specifically monitor this opportunistic pathogen.

Microflora of Secretions in a Surgical Hospital of Orthopedics and Traumatology Profile for 2021-2023 (SI “ITO NAMS of Ukraine”)

Summary. Healthcare-associated infections (HAIs), namely, surgical site infections, early postoperative and subsequent in-hospital infections, are the most common undesirable phenomenon in the world. According to statistics, at least one case of HAIs is diagnosed in every 100 hospitalized patients in hospitals of 7 developed and 15 other countries of the world at any given time. The occurrence of such complications during the treatment of a patient in a hospital leads to the need of additional diagnostic tests, additional courses of antibiotics, and unplanned surgical intervention. Worsening of the prognosis of treatment may occur due to the formation of the so-called resistant microflora in such patients, with a real probability of spreading the infection in the hospital. Prevention of HAIs in practice occurs through planned infection control in operating rooms and procedure rooms in clinical departments and qualified timely diagnostic work of certified microbiological laboratories in hospitals. Objective. The objective of the study was to determine the spectrum of microflora of secretions for three years (2021-2023) in orthopedic and trauma patients due to changes in modern injuries received more often because of military aggression and to propose the identified differences as criteria for prescribing antibacterial drugs in complex inpatient treatment. The work shows that over the past three years (2021-2023), the ratio of gram-positive and gram-negative microorganisms in the study material almost did not change and averaged 1.65. The peculiarity of the analyzed period was an increase in the number of methicillin-resistant staphylococci by 1.3 times. The spectrum of gram-negative clinical strains has changed, namely, the number of Kl.pneumoniae clinical strains with a high level of polyresistance has increased by 2.5 times. The obtained data made it possible to identify the spectrum of microflora of secretions in orthopedic and trauma patients with modern infectious complications, which prompts us to make changes in the standards of antibacterial treatment protocols, and to plan the needs for certain antibiotics in hospitals with personalization of their prescription to improve the effectiveness of treatment and reduce the risk of development of antimicrobial resistance.

Frequency of hepatitis D virus with different hepatitis B virus serological markers and coinfections in hospital patients from Argentina: synchronous testing of anti-HDV antibodies and HDV RNA.

Hepatitis D virus (HDV) RNA-positive cases with total anti-HDV antibodies nonreactive were documented. Moreover, HDV infection was observed in subjects with occult hepatitis B virus infection. The prevalence of HDV infection in Argentina is low; however, further research in different populations is needed. This study aimed to perform synchronous HDV detection in reactive hepatitis B virus patients treated in a public hospital in the province of Buenos Aires, Argentina, some of whom were coinfected with hepatitis C virus and/or HIV. A total of 189 hepatitis B virus-reactive serum samples with or without hepatitis C virus and/or HIV coinfection were synchronously analyzed for anti-HDV antibodies and HDV RNA. HDV prevalence was 4.2% with HDV RNA found in 61 samples, most of which were nonreactive to anti-HDV antibodies and hepatitis B surface antigen. Genotype 1 was identified in all HDV sequences. Moreover, triple and quadruple infections were observed, showing a high frequency of HDV infection in hospitalized patients not following the recommended diagnostic algorithm. This study is evidence that the synchronous testing of anti-HDV antibodies and HDV RNA is necessary for the diagnosis of HDV infection in Argentina. Finally, further research is necessary to identify high-risk populations and improve prevention and control strategies for triple and quadruple infections and their potential consequences.

Pilot study for the development of an automatically generated and wearable-based early warning system for the detection of deterioration of hospitalized patients of an acute care hospital.

Acute deteriorations of health status are common in hospitalized patients and are often preceded by changes in their vital signs. Events such as heart attacks, death or admission to the intensive care unit can be averted by early detection, therefore so-called Early Warning Scores (EWS) such as the National Early Warning Score 2 (NEWS2), including basic vital parameters such as heart rate, blood pressure, respiratory rate, temperature and level of consciousness, have been developed for a systematic approach. Although studies have shown that EWS have a positive impact on patient outcomes, they are often limited by issues such as calculation errors, time constraints, and a shortage of human resources. Therefore, development of tools for automatic calculation of EWS could help improve quality of EWS calculation and may improve patient outcomes. The aim of this study is to analyze the feasibility of wearable devices for the automatic calculation of NEWS2 compared to conventional calculation using vital signs measured by health care professionals. We conducted a prospective trial at a large tertiary hospital in Switzerland. Patients were given a wristband with a photoplethysmogram (PPG) sensor that continuously recorded their heart rate and respiratory rate for 3 consecutive days. Combined with data from the electronic health record (EHR), NEWS2-score was calculated and compared to NEWS2 score calculated from vital parameters in the EHR measured by medical staff. The main objective of our study was to assess the agreement between NEWS2 scores calculated using both methods. This analysis was conducted using Cohen's Kappa and Bland-Altman analysis. Secondary endpoints were compliance concerning the medical device, patient acceptance, data quality analysis and data availability and signal quality for all time stamps needed for accurate calculation. Of 210 patients enrolled in our study, NEWS2 was calculated in 904 cases, with 191 cases being directly compared to conventional measurements. Thirty-three of these measurements resulted in a NEWS2 ≥ 5, 158 in a NEWS2 < 5. Comparing all 191 measurements, accordance was substantial (K = 0.76) between conventional and automated NEWS2. No adverse effects due to the device were recorded. Patient acceptance was high. In conclusion, the study found strong agreement between automated and conventional NEWS2 calculations using wearable devices, with high patient acceptance despite some data quality challenges. To maximize the potential of continuous monitoring, further research into fully automated EWS calculations without relying on spot measurements is suggested, as this could provide a reliable alternative to traditional methods. January 26, 2023, NCT05699967.

Effect of intravenous thrombolysis with butylphthalide, edaravone and recombinant tissue plasminogen activator (rt-PA) on serum inflammatory factors in patients with ischemic stroke

Purpose: To study the impact of edaravone in combination with edaravone and recombinant tissue plasminogen activator (rt-PA) intravenous thrombolysis on serum inflammatory factors in ischemic stroke subjects. Methods: Eighty ischemic stroke patients in the First Affiliated Hospital of Xi'an Medical University, Xi’an, China were randomly assigned to study and control cohorts, each with 40 subjects. Patients in control cohort were administered edaravone and rt-PA intravenous thrombolysis. The study cohort received butylphthalide in combination with edaravone and rt-PA intravenous thrombolysis. Treatment effectiveness/efficacy, neurological function, self-care ability, inflammatory indicator levels, and blood cell levels were compared between the 2 cohorts. Results: Efficacy was significantly better in the study cohort than in the control cohort (p &lt; 0.05). After treatment, NIHSS score was significantly lower in the study cohort than in control cohort, while ADL score was significantly higher in the study cohort (p &lt; 0.05). After medication, CRP level was decreased significantly in both cohorts, but was significantly lower level in the study cohort (p &lt; 0.05). Treatment led to significant reductions in white blood cell count, neutrophil count, and NLR ratio in the study cohort, relative to the control cohort (p &lt; 0.05). Conclusion: The use of butylphthalide in combination with edaravone and rt-PA intravenous thrombolysis produces significant and beneficial effects on ischemic stroke subjects by regulating abnormal levels of inflammatory cells, improving coagulation status and decreasing inflammation. Moreover, it ameliorates neurological defects and improves activities of daily living. There is, however, a need to determine the mechanisms of action of this combination therapy and the influence of other cofounding factors on the activities of the combination therapy.

Assessment of proton pump inhibitors utilization in intensivecare units patients of a tertiary care hospital in the United ArabEmirates

Assessment of proton pump inhibitors utilization in intensivecare units patients of a tertiary care hospital in the United ArabEmirates

Clinical characteristics, in-hospital management, and outcomes among patients hospitalized for acute ischemic stroke in rural versus urban hospitals in China: A nationwide hospital-based study.

Efforts to improve rural stroke care have intensified in China. However, high-quality comprehensive data on the differences in care and outcomes between rural and urban hospitals are limited. We analyzed data on patients with acute ischemic stroke hospitalized in the China Stroke Center Alliance hospitals from 2015 to 2022. The in-hospital management measures assessed included nine acute and five discharge management measures. Outcomes evaluated included death or discharge against medical advice (DAMA), major adverse cardiovascular events (MACE), disability at discharge, and in-hospital complications. We enrolled 1,583,271 patients with acute ischemic stroke from 1930 hospitals, comprising 1086 (56.3%) rural sites with 735,452 patients and 844 (43.7%) urban sites with 847,891 patients. Patients in rural hospitals demonstrate suboptimal management measures compared to those in urban hospitals, including lower rates of intravenous recombinant tissue plasminogen activator within 4.5 h (26.0% vs 28.3%; difference: -2.3% (-2.5% to -2.0%)), endovascular treatment (0.6% vs 1.9%; difference: -1.3% (-1.3% to -1.2%)), vessel assessment (88.5% vs 92.0%; difference: -3.5% (95% confidence interval (CI): -3.6% to -3.4%)), and anticoagulants for atrial fibrillation at discharge (42.9% vs 47.7%; difference: -4.8% (95% CI: -5.4% to -4.2%)). Overall, the rural-urban disparity in in-hospital outcomes was small. Rural patients had a slightly higher rate of in-hospital death/DAMA (9.0% vs 8.0%; adjusted odds ratio (OR): 1.22 (95% CI: 1.20-1.23); adjusted risk difference (aRD): 1.3% (95% CI: 1.2%-1.4%)) and a slightly lower rate of complications (10.9% vs 13.0%; aOR: 0.83 (95% CI: 0.82-0.84); aRD: -1.3% (95% CI: -1.3% to -1.3%)). No notable rural-urban differences were observed in MACE and disability at discharge. Patients in rural hospitals demonstrated suboptimal management measures and had higher rates of in-hospital death/DAMA compared to those in urban hospitals. Prioritizing the allocation of health resources to rural hospitals is essential to improve healthcare quality and outcomes. The data supporting the findings of this study are available from the corresponding author upon reasonable request.

Secondary Sarcopenia in Patients with Locomotor Disorders: Prevalence, Diagnosis and Medical Rehabilitation. A Review

INTRODUCTION. The development of rehabilitation methods for patients with sarcopenia, a generalized age-associated loss of skeletal muscle mass and strength, is important, since sarcopenia leads to pronounced weakness, functional and motor disorders and an increased risk of death in the elderly. AIM. To analyze the prevalence, features of pathogenesis, diagnosis of secondary sarcopenia, including against the background of motor disorders due to stroke, as well as methods of treatment and medical rehabilitation of such patients. MAIN CONTENT. Among the secondary forms, sarcopenia is of the greatest clinical importance against the background of the consequences of acute cerebrovascular accident (ACA), due to muscular atrophy associated with paralysis and immobility, spasticity, inflammation and denervation of muscles, malnutrition and intestinal absorption of protein and vitamin D. Recent studies show that the prevalence of sarcopenia in stroke patients in emergency hospitals is 8.5–33.8 %, according to other data — more than 42 %. Muscle weakness after a stroke contributes to a decrease in physical functions and the development of disability, and sarcopenia leads to adverse outcomes 90 days after a stroke. According to the meta-analysis, which included 7 cohort studies with a total sample of 1,774 patients who underwent ACA, 27.1 % of them had sarcopenia. Moreover, the presence of sarcopenia negatively affected the clinical and functional outcomes of ACA, as well as the results of medical rehabilitation (odds ratio: 2.42, 95 % confidence interval: 1.76–3.33, p 0.001). CONCLUSION. Despite the prevalence and relevance of this pathology, rehabilitation programs for patients with sarcopenia against the background of the consequences of ACA have not been developed. Isolated foreign publications demonstrate the effectiveness of certain methods of physical therapy and electrical stimulation, but the evidence base for their effectiveness is low.

Rehabilitation and functional outcomes of COVID-19 patients in a rehabilitation hospital in Qatar.

Patients recovering from severe COVID-19 infections have experienced prolonged cognitive, physical, and psychological sequelae, including cardiorespiratory and motor deconditioning, neurological deterioration, anxiety, and depression. The impact of rehabilitation post-acute COVID-19 infection was recognized in the literature, but studies assessing and quantifying specific functional outcomes were lacking. This study aims to describe the characteristics and quantify the changes in functional outcomes of patients admitted to Qatar Rehabilitation Institute (QRI) for inpatient rehabilitation (IPR) post-COVID-19 infection during a 10-month period in 2021. This is a retrospective observational cohort study, which included individuals over 18 years of age with a documented COVID-19-positive diagnosis who were admitted to QRI for IPR due to COVID-19 complications. Data was collected by the investigators from January 1, 2021, until October 30, 2021. A total of 243 patients were included in this study. The changes in functional rehabilitation outcomes were assessed and quantified at both the patient's baseline (on admission to QRI) and after completion of IPR (on discharge). The duration of the IPR program varied based on each patient's baseline assessment. Patients were given a total of 8-12 weeks to achieve their rehabilitation goals and were discharged once those goals were met. Several validated tools were utilized in this study including Functional Independence Measure (FIM), Berg Balance Scale (BBS), Dynamic Gait Index (DGI), Modified Medical Research Council (mMRC) Dyspnea Scale, Mini-Mental State Examination (MMSE), and Right- and left-Hand Grip Strength. In addition, patients' diet, the need for respiratory support, and the presence of a tracheostomy tube before and after IPR were also recorded. In total, 84.4% of the included patients were males (n = 205); with a mean age of 52.44 ± 12.99 years. The most commonly reported comorbidities were type 2 diabetes (62.1%) and hypertension (49.8%) with 83.5% of patients experiencing critical illness neuromyopathy. The average patients' length of stay in QRI was 33.92 ± 27.72 days. A statistically significant improvement in all functional outcome scales was noted following the completion of the IPR program (p = 0.001). The number of patients requiring modification to their diet or feeding via nasogastric tube (NGT) significantly decreased by 35% and 93%, respectively (p = 0.001). Patients requiring respiratory support decreased by 98% (p = 0.001) and the need for a tracheostomy tube among patients was reduced by 95% (p = 0.001). IPR following COVID-19 infection was associated with significant functional, motor, and cardiorespiratory improvement. Dedicating clinics for post-COVID-19 rehabilitation would ensure improved patient outcomes and enhanced recovery.

Assessment of risk factors for myocardial infarction and its relationship with some variables

The aim of the study is to assess the risk factors which lead to myocardial infarction and relation to some variables. The filed study was carried out from the 1st of April to the end of Sept. 2005. The Sample of the study consisted of (100) patients in lbn-Albeetar and Baghdad Teaching Hospital. The result of the study indicated the following; 45% of patients with age group (41-50) were more exposed to the disease and there is no significant difference was seen in the level of education, Martial status, weight and height. The result shows that there are significant difference in risk factors like hypertension, cholesterol level in blood and diabetes. When analyzed by T.test at level of P &lt; 0.01 and there are significant difference in smoking habits, hypertension, and diabetes mellitus patient's when analyzed by chi-squire at level of P &lt; 0.01. The researcher recommends taking the Preventive measuments to control the risk factors.

Outcomes and Cost-Effectiveness of Hospital Outpatient Versus Ambulatory Surgery Center Lumbar Decompression Surgery.

Retrospective Chart Review. Outpatient spinal surgeries in Ambulatory Surgery Centers (ASCs) have gained traction due to their potential cost efficiencies and improved perioperative processes. This study aims to compare the cost-effectiveness and patient outcomes of lumbar laminectomies performed in hospital settings vs ASCs. A retrospective analysis was conducted on 771 patients who underwent 1 or 2-level outpatient laminectomy between 2019 and 2023. Patient demographics, 90-day and one-year clinical and patient-reported outcomes (PROs), and one-year episode of care costs were evaluated. A one-year cost-effectiveness analysis was performed using the EQ-5D to measure quality-adjusted life years (QALYs). ASC patients demonstrated lower body mass index and American Society of Anesthesiologists (ASA) scores, with a higher prevalence of 1-level laminectomies compared to hospital patients. ASC-based laminectomy was associated with lower initial surgery cost and one-year episode of care costs ($5662 ± 4748 vs $10229 ± 9202, P < 0.001), with similar rates of complications and postoperative resource utilization. These trends remained after controlling for patient demographics, comorbidities, and number of levels treated. In patients completing baseline and 1-year EQ-5D scores, ASC-based laminectomy was over twice as cost-effective as hospital procedures ($64873/QALY gained vs $152630). The findings support the safety and one-year cost effectiveness of ASCs for appropriately selected patient populations undergoing lumbar laminectomy. Additional studies are needed to replicate these findings across institutions, and to assess the cost effectiveness of ASC-based laminectomy beyond one-year postoperatively.

Calf circumference-albumin index significantly predicts the prognosis of older patients with cancer cachexia: A multicenter cohort study

ObjectivesThe aim of this study was to evaluate the combined prognostic value of calf circumference (CC) and serum albumin on mortality in patients with cancer cachexia aged ≥65 years. MethodsThis multicenter cohort study involved 5322 older patients in hospital with cancer cachexia. The combined indicator of CC and albumin was defined as the calf circumference-albumin (CCA) index. Harrell's C index, a time-dependent receiver operating characteristic curve analysis, was used to assess the prognostic performance of the CCA index and other indices. The optimal thresholds method was used to determine the cutoff values of CC and albumin, and the association between the CCA index and all-cause mortality was assessed using Kaplan-Meier analysis and Cox proportional hazard regression models. ResultsA total of 3875 men and 1447 women with a mean age of 72.0 years (range: 68.0–78.0 years) and a mean follow-up time of 55.0 months (range: 25.0–85.0 months) were included in the study. A total of 1269 patients were classified into the low CCA index group (0 score) by the optimal thresholds method. In the overall population, the CCA index showed better differentiating power at predicting mortality in older patients with cancer cachexia compared with CC or albumin alone (C index = 0.639; 95% CI: 0.612–0.666; P < 0.05). The time-dependent receiver operating characteristic curve showed that the CCA index had the highest prognostic value of all the measures studied (P < 0.05). In the overall population, male and female patients with a high CCA index (2 score) showed better performance than those with a low CCA index (0 or 1 score). ConclusionsThe CCA index could significantly predict the mortality of older patients with cancer cachexia, which might provide renewed assistance for future clinical management.

Comparative Effectiveness of Baricitinib Versus Tocilizumab in Hospitalized Patients With COVID-19: A Retrospective Cohort Study of the National Covid Collaborative.

COVID-19 treatment guidelines recommend baricitinib or tocilizumab for the management of hospitalized patients with COVID-19. We compared the effectiveness of baricitinib vs. tocilizumab on mortality and clinical outcomes among hospitalized patients with COVID-19. Multicenter, retrospective, propensity-weighted cohort study using a target trial emulation approach. The National COVID Cohort Collaborative (N3C), which is the largest electronic health records data on COVID-19 in the United States. The setting included 75 hospitals. Adults who were hospitalized for COVID-19. Newly initiated on baricitinib or tocilizumab. Our primary outcome was 28-day mortality. We used propensity scores with inverse probability of treatment weights (IPTWs) to control bias and confounding while comparing treatments. Among 10,661 individuals included in the study, 6,229 (58.4%) received baricitinib and 4,432 (41.6%) tocilizumab. Overall, the mean age of the cohort was 60.0 ± 15.1 years, 6429 (60.3%) were male, and 19.2% received invasive mechanical ventilation. After IPTW adjustment, baricitinib use was associated with lower 28-day mortality (odds ratio [OR], 0.91; 95% CI, 0.85-0.98) and hospital (OR, 0.88; 95% CI, 0.82-0.94) mortality compared with tocilizumab. Baricitinib was also associated with shorter hospital length of stay (incident rate ratio, 0.92; 95% CI, 0.90-0.94) and lower rates of hospital-acquired infections (OR, 0.86; 95% CI, 0.75-0.99), although no difference in ICU length of stay was noted between the two groups. In this large, diverse cohort of U.S. hospitalized adults with COVID-19, baricitinib was associated with significantly lower 28-day mortality, hospital mortality, shorter hospital length of stay, and less hospital-acquired infections compared with tocilizumab.

Noise within hospital wards: a survey method

Noise pollution is one of the most disturbing environmental factors. It directly affects people's lives, especially vulnerable people such as children, old-age, and hospital patients. Hospitals are complex buildings with manifold spaces and facilities where different users live with different sensitivity to noise. Several studies highlight the discomfort that patients, staff, and visitors experience in hospitals due to inadequate noise levels. All this leads to stress, sleep disorders, interference in communication, aggression, and annoyance. Noise exposure in hospitals is due to several sound sources. Each varies throughout the day, and their detection could be challenging. The present study proposes a clustering technique to analyze long-term sound level meter monitoring in an Italian hospital (Pisa, Tuscany). Equivalent short-term levels obtained with an interval time of 0.1 s are used as the database to exploit the occurrences curves of different chunks of the monitoring. Then, through a validated method, the spectra of different kinds of sound sources are reconstructed via the Gaussian Mixture Model. Results are compared with near-field measurements of single sources.